Abstract: Objective  To evaluate the efficacy and safety of ultrasound-guided percutaneous liposuction for easy puncture and cannulation of the autogenous arteriovenous fistula (AVF) in patients with excessive subcutaneous fat around the AVF.  Methods  Patients who underwent forearm percutaneous liposuction at the First Hospital of Hebei Medical University between September 2023 and May 2025 due to difficult dialysis cannulation resulting from thick forearm subcutaneous fat were retrospectively enrolled. Ultrasound measurements were performed to assess the skin-to-target vein depth for arteriovenous fistula (AVF) puncture and brachial artery flow before the procedure, at 3 days, and at 1 month postoperatively. The cephalic vein internal diameter was measured before and 1 month after surgery. Successful cannulation time and perioperative complications were also recorded.  Results  A total of 9 patients were enrolled in this study, with a mean age of 46.44±14.23 years and a mean body mass index (BMI) of (31.90±2.76)kg/m². All patients successfully utilized the AVF for hemodialysis after liposuction. Compared to preoperative assessments, the depth of the cannulation vein decreased significantly after the operation for 3 days (t=8.903, P＜0.001) and one month (t=13.910, P＜0.001); and diameter of the target cannulation vein increased significantly after the operation for one month (t=3.786, P=0.007). In the 5 patients without percutaneous transluminal angioplasty (PTA) within one month, flow volume in brachial artery showed no significant change after the operation for 3 days (t=0.653, P=0.550) and one month (t=0.922, P=0.409), as compared to the preoperative levels. In the 4 of the 9 patients with preoperative brachial artery flow ＞500 ml/min, successful cannulation achieved after liposuction for 22±12 days with a primary patency rate of 100% in one month; in the 5 of the 9 patients with preoperative brachial artery flow ＜500 ml/min, all required PTA treatment within 20-36 days after liposuction. The primary and secondary patency rates in one month were 100% in all patients. During the 6-month follow-up period (including one patient less than 6 months), the primary and secondary patency rates were 75% and 100%, respectively. One patient developed a hematoma at the liposuction site, which was partially resolved allowing for successful cannulation after the operation for 28 days.  Conclusion  Ultrasound-guided percutaneous liposuction is a safe, effective, and minimally invasive technique for AVF in patients with deep cannulation veins due to excessive subcutaneous fat.

Key words: Arteriovenous fistula, Percutaneous liposuction, Hemodialysis